Johannes A Govaert1,2, Niki Lijftogt1, Wouter A van Dijk3,4, Larissa N L Tseng2,5, Ronald S L Liem2,5, Rob A E M Tollenaar1, Marta Fiocco6,7, Michel W J M Wouters1,8. 1. Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands. 2. Department of Surgery, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, the Netherlands. 3. Performation, Bilthoven, Utrecht, the Netherlands. 4. X-IS, Delft, Zuid-Holland, the Netherlands. 5. Dutch Obesity Clinic, Den Haag, Zuid-Holland, the Netherlands. 6. Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands. 7. Leiden University Mathematical Institute, Leiden, Zuid-Holland, the Netherlands. 8. Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, the Netherlands.
Abstract
BACKGROUND AND OBJECTIVES: The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution. METHODS: All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used. RESULTS: Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and ≥2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obese patients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%). CONCLUSIONS: Obese surgical colorectal cancer patients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery. J. Surg. Oncol. 2016;113:489-495.
BACKGROUND AND OBJECTIVES: The objective of this study was to explore the association among adverse events, body mass index (BMI), and hospital costs after colorectal cancer surgery in a country with an intermediate BMI distribution. METHODS: All colorectal cancer procedures in 29 Dutch hospitals listed in a 2010-2012 population-based database and with a BMI > 18.5 were included (n = 8687). Hospital costs were measured uniformly and based on time-driven activity-based costing. The BMI classification of the World Health Organization was used. RESULTS:Patients in obesity classes 1 (23.6% [after risk-adjustment OR 1.245, CI 1.064-1.479, P = 0.007]) and ≥2 (28.1% [after risk-adjustment OR 1.816, CI 1.382-2.388, P < 0.001]) were associated with more severe complications and higher hospital costs (€14,294, +9.6%, after risk-adjustment +7.9%, P < 0.001; and €15,913 +22.0%, after risk-adjustment +21.2%, P < 0.001, respectively) than normal weight patients (20.8% and €13,040, respectively). Pre-obesepatients had significantly lower mortality rates (2.7%, after risk-adjustment, OR 0.756, CI 0.577-0.991, P = 0.042) than normal-weight patients (3.9%). CONCLUSIONS:Obese surgical colorectal cancerpatients in a country with an intermediate BMI distribution are associated with a significant increase in hospital costs because these patients suffer from more severe complications. This is the first study to provide evidence for the "obesity-paradox" for mortality in colorectal cancer surgery. J. Surg. Oncol. 2016;113:489-495.
Authors: Ahmed Farhat; Areg Grigorian; Ninh T Nguyen; Brian Smith; Barbara J Williams; Sebastian D Schubl; Victor Joe; Dawn Elfenbein; Jeffry Nahmias Journal: Eur J Trauma Emerg Surg Date: 2019-05-20 Impact factor: 3.693
Authors: Timothy S Nugent; Michael E Kelly; Noel E Donlon; Matthew R Fahy; John O Larkin; Paul H McCormick; Brian J Mehigan Journal: Int J Colorectal Dis Date: 2021-04-01 Impact factor: 2.571